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Indications
Major indication: paracetamol poisoning
patients with paracetamol level above or just below treatment line
all patients with potentially hepatotoxic overdose (> 150 mg/kg).
Treatment can be stopped if paracetamol concentration is below standard
treatment line but this approach avoids potentially fatal delays in treatment
all patients with evidence of severe toxicity or fulminant hepatic failure,
regardless of time since overdose
high risk patients (eg chronic alcohol abusers, malnutrition, HIV infection)
with depleted hepatic glutathione, patients on enzyme inducing drugs (eg
rifampicin, anticonvulsants, alcohol): start treatment at paracetamol levels
half those of the standard treatment line
patients unable to give a reliable history or who have taken a sequential
overdose over several hours
Other indications
toxicology: to prevent hepatotoxicity due to CHCl3 or CCl4
or neuropsychiatric sequelae of CO poisoning
cardiology: to reduce tolerance to prolonged GTN infusion; in severe
unstable angina and acute MI
acute lung injury
acute hepatic failure
oncology: to prevent cardiotoxicity of doxorubicin and reduce haemorrhagic
cystitis due cyclophosphamide and ifosfamide
Unproven or untested
anti-HIV therapy
other conditions in which damage is caused by reactive metabolites, oxygen
free radicals or depletion of glutathione
Complications
At usual doses
local skin reactions
anaphylactoid
hypertension
Overdose
severe anaphylactoid reactions
respiratory depression
haemolysis
DIC
renal failure
ARDS
GI haemorrhage
death
© Charles Gomersall December 1999
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